The Emergency Department (ED) Return Visit Quality Program launched
in 2016 with the goal to foster a culture of quality in Ontario’s EDs. In this
program, participating EDs are provided with data reports that identify return
visits resulting in admission for which the initial visit occurred at their
site. They conduct audits to investigate the causes of these return visits,
identify any quality issues or adverse events that may be present, and take
steps to address these issues.
Humber River has kindly shared their experiences increasing
awareness of sickle cell disease among ED staff to improve care in the
emergency department.
What is Sickle Cell Disease?
Every day, approximately 3,345 Ontarians are impacted by
Sickle Cell Disease (SDC). SCD is an inherited genetic condition in which
healthy red blood cell (RBCs) become misshapen, stiff, and develop a sticky
texture. This impacts the oxygen-carrying ability and lifespan of RBCs, resulting
in constant shortages. This has a variety of implications on the quality of
life of patients, as they suffer from anemia, requiring frequent blood
transfusions, vaso-occlusive crises, causing severe episodes of acute and
chronic pain, and increases their risks for bacterial infections, acute chest
syndrome, bilateral swelling of upper and lower limbs, and strokes. The
approximate age of when SDC presents is between 5 to 6 months of age.
How to Identify Sickle Cell Disease
Sickle cell crises can be precipitated by temperature
changes, stress, dehydration, and high amplitude. In some parts of the world,
the mortality from SCD remains as high as 16%, making early recognition, timely
management, and routine follow-up integral. This diagnosis of SCD is performed
using a blood test (that all babies have prior to, and immediately after,
birth), in which Hemoglobin F is replaced with Hemoglobin S-indicated by
abnormally shaped and texturized RBCs. Furthermore, there are several types of
SCD, with Sickle Cell Anemia being the most commonly diagnosed.
Treatment Pathways
The clinical treatment pathways of SDC includes supplemental
oxygen, intravenous fluids, analgesia, and blood transfusions. Moreover,
first-line treatment should have a strong emphasis on any subtle signs and
symptoms of impaired oxygenation and perfusion, resulting from clot formation
or an infectious process. Prevention strategies to minimize complications
include rest breaks during exercise, adequate hydration, and long-term pain control—however,
when these strategies fail, SCD patients require timely and efficient care in
the ED.
Sickle Cell Awareness Initiative at Humber River Hospital
Humber River Hospital recognized an opportunity to improve its delivery of care
for patients with this condition by spreading awareness of the condition among
ED staff.
The ED team at Humber River Hospital has developed a
partnership with the
Sickle Cell Awareness Group of Ontario (SCAGO), which is a charitable organization
that offers evidence-based support to families of people with sickle cell
disease across the province. SCAGO supports clinical research, engages in
psychosocial research, health promotion, patients and care providers’
education, community awareness, and development of best practices guidelines.
Collaboratively with SCAGO, Humber River Hospital continues
to update their sickle cell management protocols, educate and raise awareness
regarding the needs of sickle cell patients, and continue to focus on the safe
and effective delivery of sickle cell care in the acute care setting.
Physicians and nurses from the Humber River Hospital ED were also recently
panel members at the
SCAGO Sickle Cell Disease Virtual Summit.
This project is a great example how local clinical initiatives
can also take steps to help address imbalances in the health and care of the
Black community.
Thank you to the Humber River Hospital ED team for sharing their
story with Ontario Health.
References
- Sickle Cell Awareness Group of Ontario. Sickle Cell Within
the At-Risk Communities [Internet]. Toronto (ON): The Group; 2007 [cited 2022
Jun]. Available from:
https://sicklecellanemia.ca/sickle-cell-within-the-at-risk-communities
- Sickle Cell Awareness Group of Ontario. Black Health Matters
[Internet]. Toronto (ON): The Group; 2020 [cited 2022 Jun]. Available
from:
https://sicklecellanemia.ca/black-health-matters
- Centers for Disease Control and Prevention. What is Sickle
Cell Disease? [Internet]. The Center; 2020 [cited 2022 Jun]. Available from:
https://www.cdc.gov/ncbddd/sicklecell/facts.html
- Rees D, Williams TN, Gladwin MT. Sickle-Cell Disease. The
Lancet. 2010;376(9757):2018–2031.